Co-Use of Opioid Medications and Alcohol Prevention Study (COAPS)

公共卫生摘要 酒精和阿片类药物的联合使用被认为是一种严重的健康/安全危害--但仍然存在 尽管有这些负面影响。由于同行评议文献中可获得的信息有限，大型- 量表系统和临床研究表明，24%-38%的酒精使用障碍患者也有 阿片成瘾，寻求酒精治疗的人中过去30天阿片类药物滥用的比率为 高达68%。我们的研究表明，在接受阿片类药物治疗的社区药房患者中 在疼痛控制方面，约有20%-30%的人同时饮酒。社区药房是一种高度 有价值但未得到充分利用的资源和环境，用于识别和干预，以解决美国的阿片类药物表观- 德米奇。我们建议调整、手册和测试可接受性、可行性和初步有效性 酒精定向短期干预--社区药物治疗管理(ABI-MTM)干预 药房的病人。ABI-MTM将是一种以药房为基础的药物管理干预，与 筛查、简短干预和转诊治疗，目标是：(1)在阿片类药物期间戒酒 治疗或(2)非阿片类止痛替代疗法(与处方医生协商)。我们将进行 一项在3个社区药房地点进行的小规模试验，我们将随机选择酗酒患者 非重度酒精使用(1：1比率)与ABI-MTM(n=20)或标准药物咨询(SMC， N=20)。结果将证明干预措施的可接受性、可行性和初步效果。这项研究还将 努力确定药房系统和实践层面的障碍和促进者，以实现普遍的酒精筛查和 对阿片类药物接受者的干预。我们将开发一种混合方法评估指南来采访药房 技术员(N=20)、药剂师(N=20)和公司领导(N=20)。访谈将评估人们对以下方面的看法- 病房筛选/干预、内部组织挑战以及与ABI-MTM实施相关的流程- 为大规模的研究和实践做准备。总之，这项研究的结果将提供关键的见解，发现- 传统数据，以及执行动力试验和未来可能的系统/实践级别实施的战略。

PUBLIC HEALTH ABSTRACT Co-use of alcohol and opioid medications is known to be a serious health/safety hazard—yet persists despite these negative ramifications. With limited information available within peer-reviewed literature, large- scale system and clinical research have demonstrated 24-38% of those with alcohol use disorders also have an opioid addiction, with rates of past 30-day opioid medication misuse among those seeking alcohol treatment as high as 68%. Our research has shown that among community pharmacy patients receiving opioid medications for pain management, approximately 20-30% are engaged in co-use of alcohol. Community pharmacy is a highly valuable but underutilized resource and setting for identification and intervention to address the US opioid epi- demic. We propose to adapt, manualize, and test the acceptability, feasibility, and preliminary efficacy of an Alcohol-targeted Brief Intervention-Medication Therapy Management (ABI-MTM) intervention with community pharmacy patients. ABI-MTM will be a pharmacy-based medication management intervention, combined with Screening, Brief Intervention, and Referral to treatment that will target: (1) alcohol use elimination during opioid treatment OR (2) non-opioid pain management substitution (in consultation with the prescriber). We will conduct a small-scale trial in 3 community pharmacy locations wherein we will randomize patients with heavy alcohol use and with non-heavy alcohol use (1-to-1 ratio) to ABI-MTM (n=20) or standard medication counseling (SMC, n=20). Results will demonstrate intervention acceptability, feasibility, and preliminary efficacy. This study will also work to identify pharmacy system and practice-level barriers and facilitators for universal alcohol screening and intervention among opioid recipients. We will develop a mixed methods assessment guide to interview pharmacy technicians (N=20), pharmacists (N=20), and corporate leaders (N=20). Interviews will assess perceptions to- wards screening/intervention, internal organizational challenges, and processes related to ABI-MTM implemen- tation for large-scale research and practice. Altogether, results of this study will provide critical insights, founda- tional data, and strategies for executing a powered trial and possible future system/practice-level implementation.